Resolution Health, your Hospital Plan is anything but a Hospital Plan

My mom is with Resolution Health and she is on their "Hospital" plan option.

She was in a motor vehicle accident on Sunday (29 July 2018) evening and was taken via ambulance to the Wilgeheuwel Casualty department. She was then transferred to Flora Clinic where she was admitted early hours on Monday morning. Her hospital admission was authorised by Resolution Health.

The Surgeon assigned to my mom was concerned about something on her X-rays that she had at casualty and she therefore requested CT scans. Now you would think that these scans would be covered under the "unlimited" in-hospital benefit, but no Resolution Health has to see the reports from the scan to determine if they will pay in full. So luckily my mom has family around and I was able to go and pay for the scan beforehand (the co-payment of R1 996 and the HEFTY shortfall of R5 900 so a total of R7 896-50), but sorry to anyone who doesn't have the luxury of family or who is unresponsive after an accident and cannot make the payment themselves.

The Surgeon then requested a neurosurgeon to see my mom as there were things in the report that she was not happy with. The Neurosurgeon was not happy with the report and so he has now requested an MRI scan. BUT why trust what the doctors say when we have people at Resolution Health who, in their infinite wisdom, know better. They were apparently happy with the reports from the CT scans so they see no need to refund my mom for these nor do they see the need to be concerned about the injuries picked up by the NEUROSURGEON in the report . It's wonderful that my mom's medical aid premium (she has been paying for all these years, with out fail) includes professional medical opinions within Resolution Health too, no wonder their hospital benefits are unnecessary then.

It is now Wednesday, 1 August and my mom is still in hospital. The neurosurgeon is fed up with Resolution Health's nonsense and how it is delaying and disrupting his medical care for my mom. He will obviously not discharge her until he has had the scans done and is satisfied. Both the Neurosurgeon and the Hospital have told us that they will get the case manager, at the hospital, to get onto Resolution Health's case. As this is urgent!

So, a warning to anyone out there on Resolution Health's Hospital option , MOVE. And to anyone considering this option, go elsewhere.

And to Resolution Health, I am still awaiting your internal claims procedure so I can follow the complaints regulations laid out by the The Council for Medical Schemes. And if we are not satisfied with the outcome done internally by your department, we will then submit the report, I am busy compiling, to the short term insurance Ombud.